AAA Warman Home Care’s Weekly E-Update is intended to bring to you timely and useful articles and information at the click of the mouse. It is sent every other week in an effort to keep you apprised of what is happening across the healthcare continuum of care effecting hospital, hospice and rehabilitation social workers and case managers, as well as Assisted Living, Independent Living and Skilled Nursing facility executives. Warman understands that time is limited and has undertaken to share with you important industry information without your having to search for it.
- Anesthesia and Alzheimer’s Link. A common anesthetic may induce biomarkers of Alzheimer's disease. Isoflurane (Forane), a general anesthetic inhalant, may cause cell death and generation of an Alzheimer's-associated protein, recent research reveals.
General anesthesia may increase risk for Alzheimer's disease. One biomarker of Alzheimer's disease is the presence of plaques in the brain. Amyloid-beta protein (A-beta) is toxic to brain cells and is a key component in these plaques. Apoptosis, or cell death, is another indicator of cognitive decline. Previous research revealed application of isoflurane to neural cells in a lab led to apoptosis and the generation of A-beta.
Isoflurane can be one of the most commonly used anesthetics in operation. We use it every day," lead author Zhongcong Xie, M.D., Ph.D., of the MassGeneral Institute for Neurodegenerative Disease in Charlestown, Mass., told Ivanhoe.
Massachusetts General Hospital in Boston applied isoflurane to cultured neural cells in a series of experiments. They reported activation of caspase, an enzyme that contributes to apoptosis. When researchers applied isoflurane to neural cells that express amyloid precursor protein (APP), which aids the formation of A-beta, isoflurane raised levels of A-beta-releasing enzymes.
Study results indicate isoflurane promotes apoptosis and the production of A-beta through specific molecular pathways. Isoflurane may also initiate a process by which A-beta generation and apoptosis interact and magnify one another.
Researchers only used cultured cells in their study. Dr. Xie said while these kinds of lab studies can give scientists a preliminary understanding of how medications affect disease, it's still too early to know if the same reactions would be seen in humans.
"This is alarming, but it's still premature to come to a conclusion," said Dr. Xie. "We need to work hard to have more data to support our hypothesis that isoflurane is toxic and facilitates dementia, or cognitive dysfunction, in humans."
SOURCE: Ivanhoe interview with Zhongcong Xie, M.D., Ph.D.; The Journal of Neuroscience, 2007;27:1247-1254
- Obesity Epidemic: Double Trouble for Seniors. The obesity epidemic is far-reaching, impacting the young, old and everyone in-between. This is bad news for seniors, who gain fat and lose lean muscle mass as they age.
The combination of the obesity epidemic and aging fat has dangerous implications for older individuals. Obesity is associated with an increased risk for diabetes, heart disease, high blood pressure and arthritis. Adults ages 70 to 79 are at a critical period for the development of physical disabilities. A high level of body fat combined with loss of lean muscle mass can contribute to the onset of physical disabilities.
Recent research from Wake Forest University School of Medicine in Winston-Salem, N.C., reveals there are more obese seniors than ever before. From the early 1980s to 2000, the obesity rate in older adults doubled.
"For this extra amount, we've increased the amount of fat mass with a very moderate increase in lean mass, which means we're not just getting bigger, we're also getting fattier," lead author Jingzhong Ding, M.D., Ph.D., a Wake Forest researcher, told Ivanhoe. "We also found lean mass gradually declines and fat mass increases with age."
Researchers measured body composition changes in 1,786 adults ages 70 to 79 from 1997 to 2003. They found both men and women gained fat and lost lean muscle mass during the study. People who spent a larger proportion of their living years during the obesity epidemic were more likely to be fat. Participants split into 10 groups based on their birth year. People who were younger during the onset of the obesity epidemic were most likely to be fat. Eighty-year-old men born in 1927 had about 10 more pounds of fat and 3.75 more pounds of muscle compared to 80-year-old men born in 1918.
Statistics from the 1980s did not clearly indicate the body composition of older adults. Further research is needed to determine whether the obesity epidemic has an evident impact on the ratio of fat to muscle.
"We have this increased body size, but we don't know exactly how the fat mass and lean mass is distributed. Hopefully there will be a proportional amount of body fat and lean mass," Dr. Ding said.
This research provides further evidence of the severity of the obesity epidemic. "This trend of the obesity epidemic has crossed all age groups... Young, middle-aged and older individuals have this problem, so it seems like this epidemic is, indeed, continuing," said Dr. Ding. "We have to come up with a strategic plan and try to deal with this problem in a different way."
SOURCE: Ivanhoe interview with Jingzhong Ding, M.D., Ph.D.; The American Journal of Clinical Nutrition, 2007;85
- Depression and Artery Disease. When someone has the blues, missing out on the enjoyment of life isn't the only negative. Depression can also harden arteries.
Depression has been linked to heart disease and increased risk of death in many studies. Now, researchers report they have a better understanding of this connection. By breaking depression down into different components, researchers discovered a specific set of symptoms, including fatigue and appetite disturbances, is most closely linked to the early stages of artery disease.
Researchers from Indiana University-Purdue University Indianapolis studied 324 men and women with an average age of 60. They assessed the participants for cardiovascular risk factors, depression, and emotional state. They also used ultrasound tests to determine artery intima-media thickness (IMT), a measurement of the inner layers of the blood vessel linked to early coronary artery disease. Assessments were taken again three years later.
Participants who ranked higher on the depression scale were also more likely to have a greater change in their IMT measurement than those with lower depression scores. Specifically, the greatest change in IMT measurements were linked to the physical, rather than the cognitive and emotional, aspects of depression. The researchers report this finding may have to do with the age of the participants, as older depressed patients are more likely to suffer the physical effects of depression than younger patients.
Researchers report the findings of this study strengthen the theory of a link between depression and heart disease. Study authors write: "Identifying these components, in turn, may provide insights into the mechanisms underlying the negative emotion-CAD [coronary artery disease] relationships and may facilitate the development of focused interventions designed to reduce the CAD risk of individuals prone to experience negative emotions."
SOURCE: The Archives of General Psychiatry, 2007;64:225-233
- Nap Your Way to Heart Health Employers who want to keep their workers' hearts healthy should take a lesson from countries where an afternoon siesta is the norm.
A new study shows mid-day napping leads to a 37-percent reduction in the risk of dying from a coronary event.
The research was conducted among more than 23,000 people in Greece, where naps are part of the culture. Investigators from the University of Athens Medical School teamed up with partners at the Harvard School of Public Health to track the participants over about six years.
None of the people in the study had heart disease at the beginning of the project. By the end of the study, those who reported napping for at least 30 minutes on at least three days of the week were about one-third less likely to have died of a heart attack or other cardiac cause.
The finding was strongest for men who were still working. Those who napped on a regular basis enjoyed a 64-percent lower risk of dying from heart disease, leading researchers to conclude midday naps may help reduce job-related stress -- something previous studies have linked to higher coronary mortality rates.
The take-home message for the public: If you can catch a few Zzz's during the middle of the day, do it.
SOURCE: Archives of Internal Medicine, published online Feb. 12, 2007
- Docs Let Own Beliefs Govern Patients Care. You expect your doctors to respect your wishes when it comes to treatment options, right? A new study suggests they may not, especially when those treatment options are morally controversial.
University of Chicago researchers surveyed more than 1,000 physicians from a wide range of specialties to see how they felt about their obligation to tell patients about morally controversial treatments or refer patients to other physicians when patients asked for treatments going against the doctor's personal ethics.
The doctors were asked about three specific treatments: sedating terminally ill patients to the point of unconsciousness, prescribing contraceptives to teenagers without parental consent, and performing abortions.
Most doctors were fine with sedating terminally ill patients, but about half of the doctors had problems with the other two. And while 86 percent did feel they should lay out all the treatment options for their patients, just 71 percent of the doctors felt obligated to refer a patient to another physician for a treatment they didn't want to provide. More than half, 63 percent, of the doctors responded it was acceptable for doctors to share their ethical concerns about treatments with patients.
Male doctors who were more religious and those who personally objected to one or more of the treatments were more likely to balk at providing patients with all their options or referring them to other physicians.
The researchers report these findings show doctors often let their personal beliefs interfere with their practice of medicine. "Patients should know that physicians are divided on this issue," reports study author Farr Curlin, M.D. He suggests "[patients] talk to their physicians up front to find out where they stand. If they anticipate areas of moral disagreement, they should try to negotiate acceptable accommodations before a crisis develops."
SOURCE: The New England Journal of Medicine, 2007;356:593-600
- Ugly Toenails a Warning. Unsightly toenails may be more than a reason not to wear sandals. Now, doctors say acting quickly to eradicate fungal nail infections may save diabetic patients from amputation.
Researchers from Rosalind Franklin University North Chicago report about 75 percent of people with diabetes who are at high risk for amputation will also have diseased toenails. Spotting fungal nail infections and starting treatment quickly may help a diabetes patient avoid a more severe infection, which could force doctors to amputate a toe, a foot, or even a leg.
"If someone shows up with an ugly toenail, then that, by extension, seems to be a harbinger for a toenail infection, which is also a harbinger for complications in high risk people with diabetes," Rosalind Franklin podiatrist David Armstrong, D.P.M, M.Sc., Ph.D., told Ivanhoe. "Often the fungal toenail can also lead to athlete's foot, and athlete's foot can lead to cracks in the skin, which can lead to other types of bacterial infections."
Amputation is a serious risk for diabetes patients. People with diabetes may develop blood circulation and nerve problems in their lower extremities, which can lead to slow-healing wounds. When diabetics develop severe ulcers or infected wounds on their feet or legs, doctors must sometimes amputate the affected area to prevent the infection from spreading throughout the body.
Dr. Armstrong said a toenail infection could be the first damage in the armor. "Often so many of these problems, like amputation, start out as stupid little things, and maybe a toenail infection is one of those stupid little things," he said.
Treating a toenail infection is a slow process. After trimming away diseased portions, the doctor will prescribe a topical or oral anti-fungal medication. It can take many months for the toenail to grow out and be healthy again. However, Dr. Armstrong recommends seeking treatment to anyone who is bothered by the way his or her toenails look or feel.
"If we just get high risk patients and doctors to look at people's feet a little bit more, that's what is probably going to stop the needless number of high level amputations, not only in the United States, but around the world," said Dr. Armstrong. "I think that's the bottom line."
SOURCE: Ivanhoe interview with David G. Armstrong, D.P.M., M.Sc., Ph.D.
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